Doctors who do Symmastia repair? (photos)

Question

Hello, I had 425cc's under the muscle high profile silicone implants a year ago on August 17, 2014. From the front, it is not as noticeable, but when looking from under the breast or over it is very noticeable :( I'm looking for options (I'm by Las Vegas area) of experienced surgeons who have operated on this before please. It seems a lot of doctors in my area do not operate on this and I have been denied by a couple office staffs on my inquiry.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.Although I do not believe that you have symmastia you definitely have medially positioned breast implants and sternal skin tenting.  Generally speaking, symmastia (or medial malposition or “uni-boob”) occurs when the breast implants move too far toward the midline--the two implants may actually touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest. Again generally speaking, symmastia may result from overly aggressive attempts to alter chest wall anatomy trying to increase cleavage for patients. This outcome is made worse by use of larger implants in thin patients, and is a problem for implants over or under the muscle, though sub muscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound. Correction involves use of internal sutures of the capsule around the breast implants. Often, it is necessary to expand the breast implant pocket laterally (outwardly) to allow for correct placement of the implants.Correction of symmastia involves careful planning and intra-operative reinforcement of the medial fold of the breasts. Reconstruction usually involves removal of the breast implants and internal suture reinforcement of the involved area. The use of dyes and needles through the skin surface assists the exact placement of permanent sutures. Usually the breast implant capsule that is redundant is removed to allow for two raw surfaces to heal together, presumably lowering the rate of recurrence of the symmastia.Often, it is necessary to “open” the breast implant pocket laterally (outer breast fold) to allow for positioning of the implant centrally behind the breast mound. This maneuver may also decrease the amount of implant pressure against the medial suture line. Use of a smaller breast implant, if possible, may serve the same purpose.Correction of implant malposition issues does require some experience; make sure your plastic surgeon can demonstrate his/her experience level.  I hope this, and the attached link (dedicated to symmastia surgery concerns), helps.Best wishes.

Neil T. Chen, MD · Answer

Thank you for the question. I do not think you have symmastia although you left breast appears a little closer to the midline from the picture. Symmastia correction is not straight forward and there is different techniques for different situation. Some people may need staged repair, Often there is either capsule contraction or tightness  from the lateral side, forcing the implants more medial than desired. In other situation, there is too much room at the media side allowing the implants to move there. In any case, you will need careful evaluation to determine the best method of treatment.

George Commons, MD (retired) · Answer

Symmastia is tricky.   Repair that is certain is removal of the implants for 6 months and then replacement with a restricted dissection.    An alternative is a repair attempt with Seri liner of silk which may work.   Just call in your area and get the office that will help you.  You might try the University Surgeons.   This can be helped.    My Best,  Dr C

Doctors who do Symmastia repair? (photos)

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Doctors who do Symmastia repair? (photos)

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